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Shin-Yi Lin C, Howells J, Rutkove S, Nandedkar S, Neuwirth C, Noto YI, Shahrizaila N, Whittaker RG, Bostock H, Burke D, Tankisi H. Neurophysiological and imaging biomarkers of lower motor neuron dysfunction in motor neuron diseases/amyotrophic lateral sclerosis: IFCN handbook chapter. Clin Neurophysiol 2024; 162:91-120. [PMID: 38603949 DOI: 10.1016/j.clinph.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/07/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
This chapter discusses comprehensive neurophysiological biomarkers utilised in motor neuron disease (MND) and, in particular, its commonest form, amyotrophic lateral sclerosis (ALS). These encompass the conventional techniques including nerve conduction studies (NCS), needle and high-density surface electromyography (EMG) and H-reflex studies as well as novel techniques. In the last two decades, new methods of assessing the loss of motor units in a muscle have been developed, that are more convenient than earlier methods of motor unit number estimation (MUNE),and may use either electrical stimulation (e.g. MScanFit MUNE) or voluntary activation (MUNIX). Electrical impedance myography (EIM) is another novel approach for the evaluation that relies upon the application and measurement of high-frequency, low-intensity electrical current. Nerve excitability techniques (NET) also provide insights into the function of an axon and reflect the changes in resting membrane potential, ion channel dysfunction and the structural integrity of the axon and myelin sheath. Furthermore, imaging ultrasound techniques as well as magnetic resonance imaging are capable of detecting the constituents of morphological changes in the nerve and muscle. The chapter provides a critical description of the ability of each technique to provide neurophysiological insight into the complex pathophysiology of MND/ALS. However, it is important to recognise the strengths and limitations of each approach in order to clarify utility. These neurophysiological biomarkers have demonstrated reliability, specificity and provide additional information to validate and assess lower motor neuron dysfunction. Their use has expanded the knowledge about MND/ALS and enhanced our understanding of the relationship between motor units, axons, reflexes and other neural circuits in relation to clinical features of patients with MND/ALS at different stages of the disease. Taken together, the ultimate goal is to aid early diagnosis, distinguish potential disease mimics, monitor and stage disease progression, quantify response to treatment and develop potential therapeutic interventions.
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Affiliation(s)
- Cindy Shin-Yi Lin
- Faculty of Medicine and Health, Central Clinical School, Brain and Mind Centre, University of Sydney, Sydney 2006, Australia.
| | - James Howells
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sanjeev Nandedkar
- Natus Medical Inc, Middleton, Wisconsin, USA and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Roger G Whittaker
- Newcastle University Translational and Clinical Research Institute (NUTCRI), Newcastle University., Newcastle Upon Tyne, United Kingdom
| | - Hugh Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, WC1N 3BG, London, United Kingdom
| | - David Burke
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Kapravchuk V, Briko A, Kobelev A, Hammoud A, Shchukin S. An Approach to Using Electrical Impedance Myography Signal Sensors to Assess Morphofunctional Changes in Tissue during Muscle Contraction. BIOSENSORS 2024; 14:76. [PMID: 38391995 PMCID: PMC10886557 DOI: 10.3390/bios14020076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/24/2024]
Abstract
This present work is aimed at conducting fundamental and exploratory studies of the mechanisms of electrical impedance signal formation. This paper also considers morphofunctional changes in forearm tissues during the performance of basic hand actions. For this purpose, the existing research benches were modernized to conduct experiments of mapping forearm muscle activity by electrode systems on the basis of complexing the electrical impedance signals and electromyography signals and recording electrode systems' pressing force using force transducers. Studies were carried out with the involvement of healthy volunteers in the implementation of vertical movement of the electrode system and ultrasound transducer when the subject's upper limb was positioned in the bed of the stand while performing basic hand actions in order to identify the relationship between the morphofunctional activity of the upper limb muscles and the recorded parameters of the electro-impedance myography signal. On the basis of the results of the studies, including complex measurements of neuromuscular activity on healthy volunteers such as the signals of electro-impedance myography and pressing force, analyses of the morphofunctional changes in tissues during action performance on the basis of ultrasound and MRI studies and the factors influencing the recorded signals of electro-impedance myography are described. The results are of fundamental importance and will enable reproducible electro-impedance myography signals, which, in turn, allow improved anthropomorphic control.
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Affiliation(s)
- Vladislava Kapravchuk
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia; (A.B.); (A.K.); (A.H.); (S.S.)
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Ozmen GC, Mabrouk S, Nichols C, Berkebile J, Goossens Q, Gazi AH, Inan OT. Mid-Activity and At-Home Wearable Bioimpedance Elucidates an Interpretable Digital Biomarker of Muscle Fatigue. IEEE Trans Biomed Eng 2023; 70:3513-3524. [PMID: 37405890 PMCID: PMC11092386 DOI: 10.1109/tbme.2023.3290530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Muscle health and decreased muscle performance (fatigue) quantification has proven to be an invaluable tool for both athletic performance assessment and injury prevention. However, existing methods estimating muscle fatigue are infeasible for everyday use. Wearable technologies are feasible for everyday use and can enable discovery of digital biomarkers of muscle fatigue. Unfortunately, the current state-of-the-art wearable systems for muscle fatigue tracking suffer from either low specificity or poor usability. METHODS We propose using dual-frequency bioimpedance analysis (DFBIA) to non-invasively assess intramuscular fluid dynamics and thereby muscle fatigue. A wearable DFBIA system was developed to measure leg muscle fatigue of 11 individuals during a 13-day protocol consisting of exercise and unsupervised at-home portions. RESULTS We derived a digital biomarker of muscle fatigue, fatigue score, from the DFBIA signals that was able to estimate the percent reduction in muscle force during exercise with repeated-measures Pearson's r = 0.90 and mean absolute error (MAE) of 3.6%. This fatigue score also estimated delayed onset muscle soreness with repeated-measures Pearson's r = 0.83 and MAE = 0.83. Using at-home data, DFBIA was strongly associated with absolute muscle force of participants (n = 198, p < 0.001). CONCLUSION These results demonstrate the utility of wearable DFBIA for non-invasively estimating muscle force and pain through the changes in intramuscular fluid dynamics. SIGNIFICANCE The presented approach may inform development of future wearable systems for quantifying muscle health and provide a novel framework for athletic performance optimization and injury prevention.
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Nichols CJ, Mabrouk SA, Ozmen GC, Gazi AH, Inan OT. Validating Adhesive-Free Bioimpedance of the Leg in Mid-Activity and Uncontrolled Settings. IEEE Trans Biomed Eng 2023; 70:2679-2689. [PMID: 37027282 DOI: 10.1109/tbme.2023.3262206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Musculoskeletal health monitoring is limited in everyday settings where patient symptoms can substantially change - delaying treatment and worsening patient outcomes. Wearable technologies aim to quantify musculoskeletal health outside clinical settings but sensor constraints limit usability. Wearable localized multi-frequency bioimpedance assessment (MFBIA) shows promise for tracking musculoskeletal health but relies on gel electrodes, hindering extended at-home use. Here, we address this need for usable technologies for at-home musculoskeletal health assessment by designing a wearable adhesive-free MFBIA system using textile electrodes in extended uncontrolled mid-activity settings. METHODS An adhesive-free multimodal wearable leg MFBIA system was developed in-lab under realistic conditions (5 participants, 45 measurements). Mid-activity textile and gel electrode MFBIA was compared across multiple compound movements (10 participants). Accuracy in tracking long-term changes in leg MFBIA was assessed by correlating gel and textile MFBIA simultaneously recorded in uncontrolled settings (10 participants, 80+ measurement hours). RESULTS Mid-activity MFBIA measurements with textile electrodes agreed highly with (ground truth) gel electrode measurements (average [Formula: see text], featuring <1-Ohm differences (0.618 ± 0.340 Ω) across all movements. Longitudinal MFBIA changes were successfully measured in extended at-home settings (repeated measures r = 0.84). Participant responses found the system to be comfortable and intuitive (8.3/10), and all participants were able to don and operate the system independently. CONCLUSION This work demonstrates wearable textile electrodes can be a viable substitute for gel electrodes when monitoring leg MFBIA in dynamic, uncontrolled settings. SIGNIFICANCE Adhesive-free MFBIA can improve healthcare by enabling robust wearable musculoskeletal health monitoring in at-home and everyday settings.
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Coutinho ABB, Jotta B, Pino AV, Souza MN. Invasive dynamic electrical impedance myography during 100 s of moderate contraction in rats' gastrocnemius muscle. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:094104. [PMID: 37732831 DOI: 10.1063/5.0146061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
GOAL The present study aimed to investigate the behavior of dynamic electrical impedance myography (dEIM) signals during a 100-s period of the dynamic contraction of Wistar rats' gastrocnemius evoked by electrical stimulation and to link the variations in bioimpedance with muscular energy systems. METHODS Muscle contraction used 30% of the maximum muscular force and persisted for 100 s, along which dynamic bioimpedance signals were acquired. Based on the bioimpedance signals, two parameters, ΔZc and ΔZpc, were calculated to allow the analysis of their changes with the energy systems that supplied adenosine triphosphate (ATP) to the muscle. ΔZc indicated the variation of impedance of a twitch cycle compared to the values observed during the rest period preceding the cycle, and ΔZpc indicated slow bioimpedance variations compared to the values obtained during the rest period. RESULTS The results indicated that ΔZc followed the force behavior, achieving a change rate of ∼14%. This parameter was associated with instantaneous impedance changes owing to the occurrence of each twitch. CONCLUSION Although the findings of this study were linked to energy system processes, future studies are required for improving the understanding of the underlying mechanisms involved in dEIM. SIGNIFICANCE The results contributed to understanding the relation of energy systems that supply ATP to the muscles with dEIM variations that occurred during muscle activity.
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Affiliation(s)
- A B B Coutinho
- Biomedical Engineering Program, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
| | - B Jotta
- Biomedical Engineering Program, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
- Physical Education Program, Estácio de Sá University, Rio de Janeiro 22710-560, Brazil
| | - A V Pino
- Biomedical Engineering Program, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
| | - M N Souza
- Biomedical Engineering Program, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
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Showkat I, Khanday FA, Beigh MR. A review of bio-impedance devices. Med Biol Eng Comput 2023; 61:927-950. [PMID: 36637716 DOI: 10.1007/s11517-022-02763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023]
Abstract
Bio-impedance measurement analysis primarily refers to a safe and a non-invasive technique to analyze the electrical changes in living tissues on the application of low-value alternating current. It finds applications both in the biomedical and the agricultural fields. This paper concisely reviews the origin and measurement approaches for concepts and fundamentals of bio-impedance followed by a critical review on bio-impedance portable devices with main emphasis on the embedded system approach which is in demand due to its miniature size and present lifestyle preference of monitoring health in real time. The paper also provides a comprehensive review of various bio-impedance circuits with emphasis on the measurement and calibration techniques.
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Affiliation(s)
- Insha Showkat
- Department of Electronics and Instrumentation Technology, University of Kashmir, Hazratbal, Srinagar, Jammu and Kashmir, India
| | - Farooq A Khanday
- Department of Electronics and Instrumentation Technology, University of Kashmir, Hazratbal, Srinagar, Jammu and Kashmir, India.
| | - M Rafiq Beigh
- Department of Electronics, Govt. Degree College Sumbal, Sumbal, J&K, India
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Ozmen GC, Nichols C, Mabrouk S, Berkebile J, Lan L, Inan OT. Wearable Mid-Activity Measurement of Lower Limb Electrical Bioimpedance Estimates Vertical Ground Reaction Force Features. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:91-94. [PMID: 36085606 DOI: 10.1109/embc48229.2022.9871267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In recent years, wearable mid-activity electrical bioimpedance (EBI) sensing has been used to non-invasively track changes in edema and swelling levels within human joints. While the physiological origin of the changes in mid-activity EBI measurements have been demonstrated, EBI waveform patterns during activity have not been explored. In this work, we present a novel approach to extract waveform features from EBI measurements during gait to estimate the changes in vertical ground reaction forces (vGRF) corresponding to fatigue. Wearable EBI and vGRF data were measured from six healthy subjects during an asymmetric fatiguing protocol. For the exercised leg, the first peak of vGRF corresponding to the initial phase of simple support, decreased significantly and the loading rate increased significantly between the beginning and the end of the protocol. No significant change in these parameters were observed for the control leg. The first peak of vGRF and loading rate during the protocol (15 walking sessions) were correlated to the multi-frequency EBI features with mean Pearson's r=0.81 and r=0.777, respectively. The results of this proof-of-concept study demonstrate the feasibility of estimating biomechanical parameters during activity with wearable EBI. Clinical Relevance - The proposed wearable system and associated signal processing could enable convenient tracking of changes in vGRFs during daily living activities, allowing physiotherapists and doctors to remotely monitor the progress and adherence of their patients and thereby reducing the number of clinical visits.
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Rutkove SB, Le M, Ruehr SA, Nagy JA, Semple C, Sanchez B. Design and pilot testing of a 26-gauge impedance-electromyography needle in wild-type and ALS mice. Muscle Nerve 2022; 65:702-708. [PMID: 35383969 DOI: 10.1002/mus.27551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS Needle impedance-electromyography (iEMG) is a diagnostic modality currently under development that combines intramuscular electrical impedance with concentric electromyography (EMG) in a single needle. We designed, manufactured, and tested a prototype iEMG needle in a cohort of wild-type (WT) and SOD1G93A amyotrophic lateral sclerosis (ALS) mice to assess its ability to record impedance and EMG data. METHODS A new six-electrode, 26-gauge, iEMG needle was designed, manufactured and tested. Quantitative impedance and qualitative "gestalt" EMG were performed sequentially on bilateral quadriceps of 16-wk-old SOD1G93A ALS (N = 6) and WT (N = 6) mice by connecting the needle first to an impedance analyzer (with the animal at rest) and then to a standard EMG system (with the animal fully under anesthesia to measure spontaneous activity and briefly during awakening to measure voluntary activity). The needle remained in the muscle throughout the measurement period. RESULTS EMG data were qualitatively similar to that observed with a commercially available concentric EMG needle; fibrillation potentials were observed in 84% of the ALS mice and none of the WT mice; motor unit potentials were also readily identified. Impedance data revealed significant differences in resistance, reactance, and phase values between the two groups, with ALS animals having reduced reactance and resistance values. DISCUSSION This work demonstrates the feasibility of a single iEMG needle conforming to standard dimensions of size and function. Further progress of iEMG technology for enhanced neuromuscular diagnosis and quantification of disease status is currently in development.
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Affiliation(s)
- Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mai Le
- Haystack Diagnostics, Inc, Lowell, Massachusetts, USA
| | | | - Janice A Nagy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Carson Semple
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Sanchez
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah, USA
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Briko A, Kapravchuk V, Kobelev A, Tikhomirov A, Hammoud A, Al-Harosh M, Leonhardt S, Ngo C, Gulyaev Y, Shchukin S. Determination of the Geometric Parameters of Electrode Systems for Electrical Impedance Myography: A Preliminary Study. SENSORS 2021; 22:s22010097. [PMID: 35009640 PMCID: PMC8747741 DOI: 10.3390/s22010097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/12/2021] [Accepted: 12/18/2021] [Indexed: 12/25/2022]
Abstract
The electrical impedance myography method is widely used in solving bionic control problems and consists of assessing the change in the electrical impedance magnitude during muscle contraction in real time. However, the choice of electrode systems sizes is not always properly considered when using the electrical impedance myography method in the existing approaches, which is important in terms of electrical impedance signal expressiveness and reproducibility. The article is devoted to the determination of acceptable sizes for the electrode systems for electrical impedance myography using the Pareto optimality assessment method and the electrical impedance signals formation model of the forearm area, taking into account the change in the electrophysical and geometric parameters of the skin and fat layer and muscle groups when performing actions with a hand. Numerical finite element simulation using anthropometric models of the forearm obtained by volunteers' MRI 3D reconstructions was performed to determine a sufficient degree of the forearm anatomical features detailing in terms of the measured electrical impedance. For the mathematical description of electrical impedance relationships, a forearm two-layer model, represented by the skin-fat layer and muscles, was reasonably chosen, which adequately describes the change in electrical impedance when performing hand actions. Using this model, for the first time, an approach that can be used to determine the acceptable sizes of electrode systems for different parts of the body individually was proposed.
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Affiliation(s)
- Andrey Briko
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia; (V.K.); (A.K.); (A.T.); (A.H.); (M.A.-H.); (S.S.)
- Correspondence: ; Tel.: +7-903-261-60-14
| | - Vladislava Kapravchuk
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia; (V.K.); (A.K.); (A.T.); (A.H.); (M.A.-H.); (S.S.)
| | - Alexander Kobelev
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia; (V.K.); (A.K.); (A.T.); (A.H.); (M.A.-H.); (S.S.)
| | - Alexey Tikhomirov
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia; (V.K.); (A.K.); (A.T.); (A.H.); (M.A.-H.); (S.S.)
| | - Ahmad Hammoud
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia; (V.K.); (A.K.); (A.T.); (A.H.); (M.A.-H.); (S.S.)
| | - Mugeb Al-Harosh
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia; (V.K.); (A.K.); (A.T.); (A.H.); (M.A.-H.); (S.S.)
| | - Steffen Leonhardt
- Chair of Medical Information Technology, RWTH Aachen University, 52074 Aachen, Germany; (S.L.); (C.N.)
| | - Chuong Ngo
- Chair of Medical Information Technology, RWTH Aachen University, 52074 Aachen, Germany; (S.L.); (C.N.)
| | - Yury Gulyaev
- Kotelnikov Institute of Radioengineering and Electronics (IRE) of Russian Academy of Sciences, 125009 Moscow, Russia;
| | - Sergey Shchukin
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia; (V.K.); (A.K.); (A.T.); (A.H.); (M.A.-H.); (S.S.)
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Cebrián-Ponce Á, Irurtia A, Carrasco-Marginet M, Saco-Ledo G, Girabent-Farrés M, Castizo-Olier J. Electrical Impedance Myography in Health and Physical Exercise: A Systematic Review and Future Perspectives. Front Physiol 2021; 12:740877. [PMID: 34594243 PMCID: PMC8476966 DOI: 10.3389/fphys.2021.740877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Electrical impedance myography (EIM) is a non-invasive method that provides information about muscle health and changes that occur within it. EIM is based on the analysis of three impedance variables: resistance, reactance, and the phase angle. This systematic review of the literature provides a deeper insight into the scope and range of applications of EIM in health and physical exercise. The main goal of this work was to systematically review the studies on the applications of EIM in health and physical exercise in order to summarize the current knowledge on this method and outline future perspectives in this growing area, including a proposal for a research agenda. Furthermore, some basic assessment principles are provided. Methods: Systematic literature searches on PubMed, Scopus, SPORTDiscus and Web of Science up to September 2020 were conducted on any empirical investigations using localized bioimpedance devices to perform EIM within health and physical exercise contexts. The search included healthy individuals, elite soccer players with skeletal muscle injury, and subjects with primary sarcopenia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used to develop the systematic review protocol. The quality and risk of bias of the studies included were assessed with the AQUA tool. Results: Nineteen eligible original articles were included in this review, which were separated into three tables according to the nature of the study. The first table includes six studies on the bioelectrical characterization of muscle. The second table includes five studies analyzing muscle changes in injured elite soccer players. The third table includes studies on the short-, medium-, and long-term bioelectrical adaptations to physical exercise. Conclusions: EIM has been used for the evaluation of the muscle condition in the clinical field over the last few years, especially in different neuromuscular diseases. It can also play an important role in other contexts as an alternative to complex and expensive methods such as magnetic resonance imaging. However, further research is needed. The main step in establishing EIM as a valid tool in the scientific field is to standardize the protocol for performing impedance assessments.
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Affiliation(s)
- Álex Cebrián-Ponce
- Barcelona Sports Sciences Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), Barcelona, Spain
| | - Alfredo Irurtia
- Barcelona Sports Sciences Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), Barcelona, Spain
| | - Marta Carrasco-Marginet
- Barcelona Sports Sciences Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), Barcelona, Spain
| | - Gonzalo Saco-Ledo
- Bioenergy and Motion Analysis Laboratory, National Research Center on Human Evolution (CENIEH), Burgos, Spain
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Cole-Impedance Model Representations of Right-Side Segmental Arm, Leg, and Full-Body Bioimpedances of Healthy Adults: Comparison of Fractional-Order. FRACTAL AND FRACTIONAL 2021. [DOI: 10.3390/fractalfract5010013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The passive electrical properties of a biological tissue, referred to as the tissue bioimpedance, are related to the underlying tissue physiology. These measurements are often well-represented by a fractional-order equivalent circuit model, referred to as the Cole-impedance model. Objective: Identify if there are differences in the fractional-order (α) of the Cole-impedance parameters that represent the segmental right-body, right-arm, and right-leg of adult participants. Hypothesis: Cole-impedance model parameters often associated with tissue geometry and fluid (R∞, R1, C) will be different between body segments, but parameters often associated with tissue type (α) will not show any statistical differences. Approach: A secondary analysis was applied to a dataset collected for an agreement study between bioimpedance spectroscopy devices and dual-energy X-ray absoptiometry, identifying the Cole-model parameters of the right-side body segments of N=174 participants using a particle swarm optimization approach. Statistical testing was applied to the different groups of Cole-model parameters to evaluate group differences and correlations of parameters with tissue features. Results: All Cole-impedance model parameters showed statistically significant differences between body segments. Significance: The physiological or geometric features of biological tissues that are linked with the fractional-order (α) of data represented by the Cole-impedance model requires further study to elucidate.
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Coutinho ABB, Jotta B, Werneck-de-Castro JP, Pino AV, Souza MN. Invasive electrical impedance myography at different levels of contraction of gastrocnemius muscle of rat. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2020; 91:084103. [PMID: 32872900 DOI: 10.1063/1.5131631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
Electrical impedance myography (EIM) is as an experimental technique that associates muscle impedance with muscular activity. Changes in muscle impedance during contraction occur mainly due to changes in the morphological and physiological characteristics of muscles that lead to different impeditivities in comparison with the resting condition. There is no consensus on the details of muscular impedance during muscle activity. EIM measurements on humans are also influenced by factors such as the electrode-skin interface, layers of skin and fat, and the connective tissue that can generate undesirable effects in the impedance signal. These effects can be avoided if EIM measurements are carried out directly on the muscle by using the models of animals. This study investigates changes in the EIM signal in the gastrocnemius muscles of Wistar rats during different levels of muscular contraction. In vivo experiments were conducted on 19 male rats. The muscle was exposed, fixed on a load cell, and electrically stimulated to evoke different levels of muscle contraction. Signals of the components of impedance were analyzed against the muscular force signal. The results show moderate correlations (p < 0.05) among the impedance-related parameters of resistance (r = -0.76), reactance (r = 0.57), and phase (r = 0.53). In addition to providing an experimental protocol for the invasive collection of data on electrical impedance to minimize problems associated with surface electrodes, this study shows that of the components of impedance, resistance is most affected by the intensity of muscular contractions and that morphological changes influence impedance mainly at low intensities.
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Affiliation(s)
- A B B Coutinho
- Biomedical Engineering Program, COPPE, Universidade Federal do Rio de Janeiro, 21941-590, Brazil
| | - B Jotta
- Biomedical Engineering Program, COPPE, Universidade Federal do Rio de Janeiro, 21941-590, Brazil
| | - J P Werneck-de-Castro
- Exercise Biology Laboratory, EEFD, Universidade Federal do Rio de Janeiro, 21941-599, Brazil
| | - A V Pino
- Biomedical Engineering Program, COPPE, Universidade Federal do Rio de Janeiro, 21941-590, Brazil
| | - M N Souza
- Biomedical Engineering Program, COPPE, Universidade Federal do Rio de Janeiro, 21941-590, Brazil
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Rutkove SB, Sanchez B. Electrical Impedance Methods in Neuromuscular Assessment: An Overview. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a034405. [PMID: 30291145 DOI: 10.1101/cshperspect.a034405] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Electrical impedance methods have been used as evaluation tools in biological and medical science for well over 100 years. However, only recently have these techniques been applied specifically to the evaluation of conditions affecting nerve and muscle. This specific application, termed electrical impedance myography (EIM), is finding wide application as it can provide a quantitative index of muscle condition that can assist with diagnosis, track disease progression, and assess the beneficial impact of therapy. Using noninvasive surface methods, EIM has been studied in a number of conditions ranging from amyotrophic lateral sclerosis to muscular dystrophy to disuse atrophy. Data support that the technique is sensitive to disease status and can offer the possibility of performing clinical trials with fewer subjects than would otherwise be possible. Recent advances in the field include improved approaches for using EIM as a "virtual biopsy" and the development of combined needle impedance-electromyography technology.
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Affiliation(s)
- Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
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Mabrouk S, Hersek S, Jeong HK, Whittingslow D, Ganti VG, Wolkoff P, Inan OT. Robust Longitudinal Ankle Edema Assessment Using Wearable Bioimpedance Spectroscopy. IEEE Trans Biomed Eng 2019; 67:1019-1029. [PMID: 31295102 DOI: 10.1109/tbme.2019.2927807] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We present a robust methodology for tracking ankle edema longitudinally based on bioimpedance spectroscopy (BIS). METHODS We designed a miniaturized BIS measurement system and employed a novel calibration method that enables accurate, high-resolution measurements with substantially lower power consumption than conventional approaches. Using this state-of-the-art wearable BIS measurement system, we developed a differential measurement technique for robust assessment of ankle edema. This technique addresses many of the major challenges in longitudinal BIS-based edema assessment, including day-to-day variability in electrode placement, positional/postural variability, and intersubject variability. RESULTS We first evaluated the hardware in bench-top testing, and determined the error of the bioimpedance measurements to be 0.4 Ω for the real components and 0.54 Ω for the imaginary components with a resolution of 0.2 Ω. We then validated the hardware and differential measurement technique in: 1) an ex vivo, fresh-frozen, cadaveric limb model, and 2) a cohort of 11 human subjects for proof of concept (eight healthy controls and five subjects with recently acquired acute unilateral ankle injury). CONCLUSION The hardware design, with novel calibration methodology, and differential measurement technique can potentially enable long-term quantification of ankle edema throughout the course of rehabilitation following acute ankle injuries. SIGNIFICANCE This could lead to better-informed decision making regarding readiness to return to activities and/or tailoring of rehabilitation activities to an individual's changing needs.
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Kwon H, Malik WQ, Rutkove SB, Sanchez B. Separation of Subcutaneous Fat From Muscle in Surface Electrical Impedance Myography Measurements Using Model Component Analysis. IEEE Trans Biomed Eng 2018; 66:354-364. [PMID: 29993468 DOI: 10.1109/tbme.2018.2839977] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Electrical impedance myography (EIM) is a relatively new technique to assess neuromuscular disorders (NMD). Although the application of EIM using surface electrodes (sEIM) has been adopted by the neurology community in recent years to evaluate NMD status, sEIM's sensitivity as a biomarker of skeletal muscle condition is impacted by subcutaneous fat (SF) tissue. Here, we develop a method that is able to remove the contribution of SF from sEIM data. METHODS We evaluate independent component analysis (ICA) and principal component analysis (PCA) for this purpose. Then, we introduce the so-called model component analysis (MCA). All methods are validated with numerical simulations using impedivity data from SF and muscle tissues. The methods are then tested with measurements performed in diseased individuals ( n=3). RESULTS Simulations demonstrate that MCA is the most accurate method at separating the impedivity of SF and muscle tissues with the accuracy being 99.2%, followed by ICA with 51.4%, and finally PCA with 38.5%. Experimental results from sEIM data measured on the triceps brachii of patients are consistent with muscle grayscale level values obtained using ultrasound imaging. CONCLUSION MCA can be used to separate the impedivity of SF and muscle tissues from sEIM data, thus increasing the sensitivity to detect changes in the muscle. SIGNIFICANCE MCA can make the sEIM technique a better diagnostic tool and biomarker of disease progression and response to therapy by removing the confounding effect of SF tissue in NMD patients with excess subcutaneous fat tissue for any reason.
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Sanchez B, Rutkove SB. Electrical Impedance Myography and Its Applications in Neuromuscular Disorders. Neurotherapeutics 2017; 14:107-118. [PMID: 27812921 PMCID: PMC5233633 DOI: 10.1007/s13311-016-0491-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Electrical impedance myography (EIM) refers to the specific application of electrical bioimpedance techniques for the assessment of neuromuscular disorders. In EIM, a weak, high-frequency electrical current is applied to a muscle or muscle group of interest and the resulting voltages measured. Among its advantages, the technique can be used noninvasively across a variety of disorders and requires limited subject cooperation and evaluator training to obtain accurate and repeatable data. Studies in both animals and human subjects support its potential utility as a primary diagnostic tool, as well as a biomarker for clinical trial or individual patient use. This review begins by providing an overview of the current state and technological advances in electrical impedance myography and its specific application to the study of muscle. We then provide a summary of the clinical and preclinical applications of EIM for neuromuscular conditions, and conclude with an evaluation of ongoing research efforts and future developments.
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Affiliation(s)
- Benjamin Sanchez
- Department of Neurology, Division of Neuromuscular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Seward B Rutkove
- Department of Neurology, Division of Neuromuscular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
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Sanchez B, Pacheck A, Rutkove SB. Guidelines to electrode positioning for human and animal electrical impedance myography research. Sci Rep 2016; 6:32615. [PMID: 27585740 PMCID: PMC5009322 DOI: 10.1038/srep32615] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/10/2016] [Indexed: 12/14/2022] Open
Abstract
The positioning of electrodes in electrical impedance myography (EIM) is critical for accurately assessing disease progression and effectiveness of treatment. In human and animal trials for neuromuscular disorders, inconsistent electrode positioning adds errors to the muscle impedance. Despite its importance, how the reproducibility of resistance and reactance, the two parameters that define EIM, are affected by changes in electrode positioning remains unknown. In this paper, we present a novel approach founded on biophysical principles to study the reproducibility of resistance and reactance to electrode misplacements. The analytical framework presented allows the user to quantify a priori the effect on the muscle resistance and reactance using only one parameter: the uncertainty placing the electrodes. We also provide quantitative data on the precision needed to position the electrodes and the minimum muscle length needed to achieve a pre-specified EIM reproducibility. The results reported here are confirmed with finite element model simulations and measurements on five healthy subjects. Ultimately, our data can serve as normative values to enhance the reliability of EIM as a biomarker and facilitate comparability of future human and animal studies.
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Affiliation(s)
- Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
| | - Adam Pacheck
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
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Li L, Li X, Hu H, Shin H, Zhou P. The Effect of Subcutaneous Fat on Electrical Impedance Myography: Electrode Configuration and Multi-Frequency Analyses. PLoS One 2016; 11:e0156154. [PMID: 27227876 PMCID: PMC4882074 DOI: 10.1371/journal.pone.0156154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 05/10/2016] [Indexed: 11/19/2022] Open
Abstract
This study investigates the impact of the subcutaneous fat layer (SFL) thickness on localized electrical impedance myography (EIM), as well as the effects of different current electrodes, varying in distance and direction, on EIM output. Twenty-three healthy subjects underwent localized multi-frequency EIM on their biceps brachii muscles with a hand-held electrode array. The EIM measurements were recorded under three different configurations: wide (or outer) longitudinal configuration 6.8 cm, narrow (or inner) longitudinal configuration 4.5 cm, and narrow transverse configuration 4.5 cm. Ultrasound was applied to measure the SFL thickness. Coefficients of determination (R2) of three EIM variables (resistance, reactance, and phase) and SFL thickness were calculated. For the longitudinal configuration, the wide distance could reduce the effects of the subcutaneous fat when compared with the narrow distance, but a significant correlation still remained for all three EIM parameters. However, there was no significant correlation between SFL thickness and reactance in the transverse configuration (R2 = 0.0294, p = 0.434). Utilizing a ratio of 50kHz/100kHz phase was found to be able to help reduce the correlation with SFL thickness for all the three configurations. The findings indicate that the appropriate selection of the current electrode distance, direction and the multi-frequency phase ratio can reduce the impact of subcutaneous fat on EIM. These settings should be evaluated for future clinical studies using hand-held localized arrays to perform EIM.
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Affiliation(s)
- Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- TIRR Memorial Hermann Research Center, Houston, Texas, United States of America
| | - Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- TIRR Memorial Hermann Research Center, Houston, Texas, United States of America
| | - Huijing Hu
- Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, Guangdong, China
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- TIRR Memorial Hermann Research Center, Houston, Texas, United States of America
| | - Henry Shin
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- TIRR Memorial Hermann Research Center, Houston, Texas, United States of America
| | - Ping Zhou
- Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, Guangdong, China
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- TIRR Memorial Hermann Research Center, Houston, Texas, United States of America
- * E-mail:
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Li L, Shin H, Li X, Li S, Zhou P. Localized Electrical Impedance Myography of the Biceps Brachii Muscle during Different Levels of Isometric Contraction and Fatigue. SENSORS 2016; 16:s16040581. [PMID: 27110795 PMCID: PMC4851095 DOI: 10.3390/s16040581] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/11/2016] [Accepted: 04/17/2016] [Indexed: 11/16/2022]
Abstract
This study assessed changes in electrical impedance myography (EIM) at different levels of isometric muscle contraction as well as during exhaustive exercise at 60% maximum voluntary contraction (MVC) until task failure. The EIM was performed on the biceps brachii muscle of 19 healthy subjects. The results showed that there was a significant difference between the muscle resistance (R) measured during the isometric contraction and when the muscle was completely relaxed. Post hoc analysis shows that the resistance increased at higher contractions (both 60% MVC and MVC), however, there were no significant changes in muscle reactance (X) during the isometric contractions. The resistance also changed during different stages of the fatigue task and there were significant decreases from the beginning of the contraction to task failure as well as between task failure and post fatigue rest. Although our results demonstrated an increase in resistance during isometric contraction, the changes were within 10% of the baseline value. These changes might be related to the modest alterations in muscle architecture during a contraction. The decrease in resistance seen with muscle fatigue may be explained by an accumulation of metabolites in the muscle tissue.
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Affiliation(s)
- Le Li
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston; TIRR Memorial Hermann Research Center, Houston, TX 77030, USA.
| | - Henry Shin
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston; TIRR Memorial Hermann Research Center, Houston, TX 77030, USA.
| | - Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston; TIRR Memorial Hermann Research Center, Houston, TX 77030, USA.
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston; TIRR Memorial Hermann Research Center, Houston, TX 77030, USA.
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston; TIRR Memorial Hermann Research Center, Houston, TX 77030, USA.
- Guangdong Work Injury Rehabilitation Center, Guangzhou 510440, China.
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Sanchez B, Li J, Geisbush T, Bragos R, Rutkove SB. A pilot spectroscopy study on time-varying bioimpedance during electrically-induced muscle contraction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:3739-42. [PMID: 25570804 DOI: 10.1109/embc.2014.6944436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Alterations in the health of muscles can be evaluated through the use of electrical impedance myography (EIM). To date, however, nearly all work has relied upon single-frequency/spectroscopy stepped-sine measurements of static muscle (contracted or relaxed). In this work, we assessed the temporal alterations in the impedance spectrum (1 kHz to 1 MHz) behavior of gastrocnemius during the active process of muscle contraction. The approach is based on the multisine impedance spectroscopy technique. The gastrocnemii of a wild type mouse was measured during electrically-induced muscle contraction via direct current stimulation of the sciatic nerve. The processes of contraction and relaxation were clearly identified in the time-frequency impedance spectrum likely corresponding to an increase muscle fiber diameter. The technique of dynamic multisine EIM has the potential of providing useful insights into contractile mechanisms of muscle in health and disease.
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